Valvuloplasty, Mitral Valve, with Cardiopulmonary Bypass; Radical Reconstruction, with or without Ring

Name of the Procedure:

• Common Name: Mitral Valve Repair
• Technical Term: Mitral Valve Valvuloplasty with Cardiopulmonary Bypass; Radical Reconstruction, with or without Ring

Summary

Mitral valve valvuloplasty is a surgical procedure to repair a damaged mitral valve in the heart. The surgery involves stopping the heart and using a heart-lung machine (cardiopulmonary bypass) to maintain blood circulation while the valve is repaired. This can include reconstructing the valve and possibly using a ring to maintain its shape.

Purpose

• Medical Condition: Mitral valve stenosis or regurgitation, conditions where the mitral valve doesn't fully open or close properly.
• Goals/Outcomes: Restoring proper blood flow through the heart, relieving symptoms like shortness of breath and fatigue, and preventing further heart complications.

Indications

• Symptoms such as severe shortness of breath, fatigue, heart palpitations, or heart failure.
• Diagnostic tests indicating significant mitral valve dysfunction (e.g., echocardiogram, cardiac MRI).
• Patients not responding adequately to medication or less invasive treatments.

Preparation

• Pre-procedure Instructions: Patients may need to fast for 8-12 hours before the procedure. Medication adjustments, particularly blood thinners or heart medications, may be necessary.
• Diagnostic Tests: Preoperative tests typically include an echocardiogram, electrocardiogram (ECG), chest X-ray, and blood tests.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical cut is made in the chest to access the heart.
3. Cardiopulmonary Bypass: A heart-lung machine takes over the function of the heart and lungs during the procedure.
4. Valve Repair: The surgeon repairs the mitral valve, which may include removing or reshaping tissue, and using a ring to support the valve's structure.
5. Completion: The heart is restarted, and the incision is closed.

Duration

Typically, the procedure takes 3 to 5 hours.

Setting

This procedure is performed in a hospital operating room equipped with specialized cardiac surgery capabilities.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates heart-lung machine)

Risks and Complications

• Common Risks: Infection, bleeding, arrhythmias (irregular heartbeats).
• Rare Risks: Stroke, heart attack, blood clots, kidney failure. Complications are managed with medications, additional surgeries, or specialized postoperative care.

Benefits

• Improved heart function and blood flow.
• Relief from symptoms such as shortness of breath and fatigue.
• Enhanced quality of life and decreased risk of future heart complications. Benefits may be realized within weeks to a few months post-surgery.

Recovery

• Post-procedure Care: Hospital stay of about 5-7 days, monitoring in an intensive care unit initially.
• Instructions: Gradual return to normal activities over a span of 6-8 weeks, restrictions on heavy lifting, and follow-up appointments with a cardiologist.
• Ongoing cardiac rehabilitation and medications as prescribed.

Alternatives

• Medication Therapy: Managing symptoms with medications (does not fix valve).
• Balloon Valvuloplasty: Less invasive, using a balloon to open up the valve (suitable for some cases).
• Valve Replacement Surgery: Replacing the damaged valve instead of repairing it. Each alternative has specific indications, benefits, and risks, which should be discussed with a healthcare provider.

Patient Experience

• During the Procedure: The patient is under general anesthesia and does not feel pain.
• After the Procedure: Pain at the incision site managed with pain relievers, some discomfort from the chest incision, and a gradual increase in activity levels as recovery progresses. Pain management, physical therapy, and support from healthcare professionals are provided to ensure comfort and a smooth recovery.